PDF(Pubmed)
Abstract：
UNASSIGNED: Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events.
UNASSIGNED: To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals.
UNASSIGNED: The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point.
UNASSIGNED: Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23-16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79-20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly greater for the direct simulation group compared to the train-the-trainer group immediately post-training (89%+/-7 versus 74%+/-8, P-value<.01) and at 3-months (88%+/-7 versus 76%+/-12, P-value<.01). Comparisons between groups showed no difference in confidence and attitude scores at these timepoints. Both direct simulation participants and train-the-trainer instructors preferred virtual education, or a hybrid structure, over in-person education.
UNASSIGNED: Virtual education for obstetric simulation training is feasible, acceptable, and effective. Utilizing a direct simulation model for postpartum hemorrhage management resulted in enhanced knowledge acquisition and retention compared to a train-the-trainer model.
UNASSIGNED: To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals.
UNASSIGNED: The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point.
UNASSIGNED: Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23-16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79-20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly greater for the direct simulation group compared to the train-the-trainer group immediately post-training (89%+/-7 versus 74%+/-8, P-value<.01) and at 3-months (88%+/-7 versus 76%+/-12, P-value<.01). Comparisons between groups showed no difference in confidence and attitude scores at these timepoints. Both direct simulation participants and train-the-trainer instructors preferred virtual education, or a hybrid structure, over in-person education.
UNASSIGNED: Virtual education for obstetric simulation training is feasible, acceptable, and effective. Utilizing a direct simulation model for postpartum hemorrhage management resulted in enhanced knowledge acquisition and retention compared to a train-the-trainer model.
摘要：
美国的孕产妇死亡率正在上升，许多死亡是可以预防的。紧急情况,如产后出血，在非教学中发生的频率较低，农村,和城市低出生率医院。迫切需要无障碍，以证据为基础,和可持续的跨专业教育，为临床团队创造机会实践他们对罕见的反应，而是潜在的毁灭性事件。
■评估虚拟仿真培训在中低量分娩医院管理产后出血的可行性。
■该研究发生在2021年12月至2022年3月之间，在美国的8家非学术医院中进行了低至中等的分娩量，随机分为两种模式之一：直接模拟训练和培训师训练。在直接模拟训练模型中,仿真教师与参与者进行了虚拟仿真培训计划。在教练训练模型中，模拟教师与新的模拟教师就如何准备和进行模拟课程进行了虚拟课程。在这次培训之后,讲师在各自的医院领导了自己的模拟训练计划。在3个时间点，通过对产后出血知识的多项选择问卷以及信心和态度调查，对直接模拟训练参与者和新教练从培训师计划中接受培训的学生进行了评估：之前，紧接着,在3个月的培训后。进行配对t检验以评估跨时间点的教学模式中知识和信心的变化。进行ANOVA以在每个时间点对教学模式之间的知识和信心的差异进行横截面测试。
■直接模拟训练参与者（n=22）和培训教练教练的学生（n=18）包括护士，产科认证护士助产士和主治医师，家庭实践或麻醉学。直接模拟参与者与培训师培训课程的讲师学生之间的平均课程前知识和信心分数在统计学上没有差异（分别为79％/-13和75％/-14，P值=.45）。在直接模拟组中，从培训前到培训后，知识和信心得分显着提高(知识得分平均差9.81[95%CI3.23-16.40]，P值<.01；置信度得分平均差13.64[95%CI6.79-20.48]，P值<.01)，培训后维持3个月。在教练训练小组内，与课程前或课程后3个月的评分相比,干预后即刻的知识和信心评分无显著差异.直接模拟组的平均知识得分明显高于训练后训练组（89%+/-7对74%+/-8，P值<.01）和3个月时（88%+/-7对76%+/-12，P值<.01）。组间比较显示，在这些时间点，信心和态度得分没有差异。直接模拟参与者和培训教练教练都更喜欢虚拟教育，或混合结构，而不是面对面的教育。
■产科模拟训练虚拟教育是可行的,可接受,而且有效。与培训师模型相比，利用直接模拟模型进行产后出血管理可增强知识的获取和保留。
■评估虚拟仿真培训在中低量分娩医院管理产后出血的可行性。
■该研究发生在2021年12月至2022年3月之间，在美国的8家非学术医院中进行了低至中等的分娩量，随机分为两种模式之一：直接模拟训练和培训师训练。在直接模拟训练模型中,仿真教师与参与者进行了虚拟仿真培训计划。在教练训练模型中，模拟教师与新的模拟教师就如何准备和进行模拟课程进行了虚拟课程。在这次培训之后,讲师在各自的医院领导了自己的模拟训练计划。在3个时间点，通过对产后出血知识的多项选择问卷以及信心和态度调查，对直接模拟训练参与者和新教练从培训师计划中接受培训的学生进行了评估：之前，紧接着,在3个月的培训后。进行配对t检验以评估跨时间点的教学模式中知识和信心的变化。进行ANOVA以在每个时间点对教学模式之间的知识和信心的差异进行横截面测试。
■直接模拟训练参与者（n=22）和培训教练教练的学生（n=18）包括护士，产科认证护士助产士和主治医师，家庭实践或麻醉学。直接模拟参与者与培训师培训课程的讲师学生之间的平均课程前知识和信心分数在统计学上没有差异（分别为79％/-13和75％/-14，P值=.45）。在直接模拟组中，从培训前到培训后，知识和信心得分显着提高(知识得分平均差9.81[95%CI3.23-16.40]，P值<.01；置信度得分平均差13.64[95%CI6.79-20.48]，P值<.01)，培训后维持3个月。在教练训练小组内，与课程前或课程后3个月的评分相比,干预后即刻的知识和信心评分无显著差异.直接模拟组的平均知识得分明显高于训练后训练组（89%+/-7对74%+/-8，P值<.01）和3个月时（88%+/-7对76%+/-12，P值<.01）。组间比较显示，在这些时间点，信心和态度得分没有差异。直接模拟参与者和培训教练教练都更喜欢虚拟教育，或混合结构，而不是面对面的教育。
■产科模拟训练虚拟教育是可行的,可接受,而且有效。与培训师模型相比，利用直接模拟模型进行产后出血管理可增强知识的获取和保留。
